Child Abuse Underreported by Primary Health Care Providers

Although experts, primary care providers agree about the suspicion of abuse in 81 percent of cases

FRIDAY, Nov. 11 (HealthDay News) -- There is general agreement between child abuse experts and primary health care providers (PHCPs) concerning the assessment of suspected child abuse, but PHCPs report fewer cases of child abuse injuries to child protective services (CPS) than the experts, according to a report published online Oct. 13 in Academic Pediatrics.

Robert Sege, M.D., Ph.D., from the Boston University School of Medicine, and colleagues examined the validity of PHCPs' assessment of suspicious childhood injuries and their decision-making regarding reporting to CPS in a subsample of 111 injury visits drawn from 15,003 childhood injuries evaluated in the Child Abuse Recognition and Evaluation Study. Expert reviews and provider retrospective self-assessments were used to validate PHCPs' initial decision. Clinical vignettes generated from PHCP-collected data about the patient encounter were reviewed by five child abuse experts. PHCPs' opinions were elicited and evaluated six weeks and six months after the injury-related visits.

The authors found that PHCPs and experts agreed about the suspicion of abuse in 81 percent of cases. Twenty one percent of injuries that experts would have reported were not reported by PHCPs. Compared to experts, the sensitivity of child abuse reporting was 68 percent and specificity 96 percent for PHCPs. The frequency of primary care follow-up in the six months after the index visit was not reduced by the PHCP's decision to report suspected child abuse to CPS.

"Child abuse experts and PHCPs are in general agreement concerning the assessment of suspected child physical abuse, although experts would have reported suspected abuse to CPS more frequently than the PHCPs," the authors write.